Diseases of the colon and rectum
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This prospective study assessed methods of detecting intraperitoneal ischemia and inflammatory response in patients with and without postoperative complications after anterior resection of the rectum. ⋯ The intraperitoneal lactate/pyruvate ratio and cytokines, IL-6, IL-10, and TNF-alpha, were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.
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Surgery of the primary tumor in patients with colorectal cancer and unresectable synchronous liver metastases remains controversial. This study was designed to evaluate predictive preoperative factors of early postoperative death (<3 months) in such patients. ⋯ In patients with colorectal cancer and synchronous unresectable liver metastases, the three-month mortality rate was high (28 percent). Thus, better knowledge of risk factors could help select patients who could possibly benefit from surgery. The study suggested that age older than 75 years and liver cytolysis (>1.5 N) are associated with an increased three-month postoperative death risk. In these patients, surgery should be avoided.
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The Karydakis procedure is one of the asymmetric flap techniques used in the treatment of sacrococcygeal pilonidal sinus disease. The procedure consists of an asymmetrical elliptical excision, mobilization of the flap from the median side of the wound, fixation of the base of the flap to the sacrococcygeal fascia, and suturing of its edge to the lateral one. A modification of the original technique consisting of unfixing the base of the flap to the sacrococcygeal fascia with the purpose of flattening the natal cleft has been applied and its results evaluated. ⋯ The low complication rate, short hospital stay, short healing time, high degree of patient satisfaction, and absence of recurrence render the present modified technique a viable option in the management of sacrococcygeal pilonidal sinus disease.